Objective
To explore the effect of early nasogastric tubing bile reinfusion on gastrointestinal function recovery for patients undergoing laparoscopic bileduct operation.
Methods
One hundred patients undergoing laparoscopic bileduct operation were divided into observation group and control group with 50 cases each by random digits table method. The control group received routine nursing, and the observation group received early nasogastric tubing bile reinfusion on the basis of routine nursing. The recovery of postoperative gastrointestinal function and the incidence of postoperative abdominal distention between the two groups were observed and compared.
Results
The length of time needed for intestinal voice restoration and exhausting were (17.12±3.88) ,(33.92±8.96) h in observation group,and (24.08±7.25),(43.64±11.18) h in control group,and the differences were statistically significant (t = 5.99, 4.80,P <0.01). The incidence of postoperative abdominal distension was 22%(11/50) in observation group,and 42%(21/50) in control group, and the difference was statistically significant (χ2= 4.60,P <0.05).
Conclusions
The early nasogastric tubing bile reinfusion in patients undergoing laparoscopic bileduct operation can effective promote their gastrointestinal function recovery and reduce the occurrence of postoperative abdominal distension.
Key words:
Choledocholithiasis; Bile; Nursing care; Laparoscopic surgery; Functional gastrointestinal disorders
Renal cell carcinoma with fibromyomatous stroma (RCCFMS) include ELOC/TCEB1 -mutated renal cell carcinoma (RCC) and those with TSC1/2 / MTOR alterations. Besides morphologic similarity, most of these tumors is known to be diffusely positive for carbonic anhydrase IX and cytokeratin 7 by immunohistochemistry. We previously showed strong and diffuse expression of GPNMB (glycoprotein nonmetastatic B) in translocation RCC and eosinophilic renal neoplasms with known TSC1/2/MTOR alterations. We retrospectively identified molecularly confirmed cases of TCEB1/ELOC -mutated RCC (7 tumors from 7 patients), and RCCFMS with alterations in TSC1/2/MTOR (6 tumors from 5 patients, 1 patient with tuberous sclerosis syndrome). In addition, we included 7 clear cell papillary renal cell tumors (CCPRCTs) and 8 clear cell RCC, as they can also present morphologic overlap with RCCFMS. Morphologically, RCCs with TSC1/2/MTOR alterations and those with TCEB1/ELOC mutations were indistinguishable and characterized by papillary, nested, or tubular architecture, with tumor cells with clear cytoplasm and low nuclear grade. By immunohistochemistry, cytokeratin 7 was positive in 5/7 (71%) of TCEB1/ELOC -mutated RCCs, 6/6 (100%) of RCCs with TSC1/2/mTOR alterations, and 7/7 (100%) of CCPRCTs ( P =not significant). Carbonic anhydrase IX was positive in 7/7 TCEB1/ELOC -mutated RCCs, 6/6 (100%) of RCCs with TSC1/2/MTOR alterations, and 7/7 (100%) of CCPRCTs ( P =NS). GPNMB was strongly and diffusely positive in all tumors with TSC1/2/MTOR alterations (6/6), while negative in all TCEB1/ELOC -mutated RCCs (0/6), or CCPRCTs (0/7) ( P =0.002). Two of 8 clear cell RCC showed focal weak staining, while 6/8 were negative. In conclusion, the results support the use of GPNMB to distinguish RCCFMS with TSC1/2/MTOR alterations from others with similar morphology.
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